psychosomaticdisorder and it's physiotherapy management

Psychosomatic disorder

1. Psychosomatic Disorder Nabina Paneru

2. Introduction Psychosomatic means mind and body. A psychosomatic disorder is a disease involving both mind and body. Psychosomatic also called Psycho – physiologic disorder, condition in which psychological stresses adversely affect physiological (somatic) functioning to the point of distress.

3. Definition A group of mental ailments in which emotional stress is a contributing factor to physical problems involving an organ system under involuntary control. - Bimala Kapoor, 1994 Disorders in which psychic elements are significant in initiating alteration in chemical, physiological or structure of the individual resulting in physical symptoms. - Sreevani R

4. Classification Psychosomatic illnesses can be classified in three general forms: The first form includes those who experience both a mental illness and a medical one; these illnesses complicate the symptoms and management of each other. The second form includes those who experience a psychiatric issue that is a direct result of a medical illness or its treatment; having depression due to cancer and its treatment for example. The third form of psychosomatic illness is, 'somatoform,' disorders. Somatoform disorders are psychiatric ones that are displayed through physical issues.

5. Somatoform disorder Somatoform disorders are mental illness characterize by the presentation of physical symptoms with no medical explanations. The symptoms are severe enough to interfere with the patients ability to function in social or occupational activities.

6. Types of Somatoform disorder Somatization disorder: Multiple somatic symptoms in absence of any physical disorder. The symptoms are recurrent and chronic (at least 2 year duration is needed for diagnosis). It begins before age 30. Conversion Disorder: An expression of psychological conflict or need that involves an alteration or loss of physical functioning that suggests a bodily cause in the absence of a medical reason.

7. Contd. 3. Body Dysmorphic Disorder: An obsession or preoccupation with an imaginary or minor flaw such as wrinkles, small breasts, or the size or shape of another part of the person's body. Body dysmorphic disorder causes severe anxiety and might impact a person's ability to function as usual in their daily life.

8. Contd. 4. Hypochondriasis: Preoccupation with having or contracting a serious disease in the absence of medial reason

9. Contd. 5. Pain disorder: Preoccupation with pain in the absence of an adequate physical basis for it.

10. Etiology 1. Individual exhibit specific physiological responses to certain emotions. E.g. in person to the emotion of anger, person may experience peripheral vasoconstriction, resulting in an increase in blood pressure.

11. Contd. 2. Personality Theory: individuals with specific personality traits are predisposed to certain disease processes: Personality Characters Psychosomatic disorder 1. Dependence personality  Asthma 2. Repressed, anger  Peptic ulcer and HTN 3. Aggressive, ambitious  Coronary heart disease 4. Compulsive and perfectionist  Migraine 5. Self sacrificing & inhibited  Rheumatoid arthritis & ulcerative colitis

12. Contd. Family Dynamic Theory: Pathogenic family pattern in childhood, stressful and conflicting interpersonal relationship among family members. Biological theory: (Genetic predisposition): First degree relatives, monozygotic twins are prone to develop psychosomatic disorders.

13. Possible progression of psychosomatic disorders Prolonged anxiety Persistent psycho – physiological reactions Structural alteration, cellular disease and functional impairment Psychosomatic Disorders

14. Some Important Psychosomatic Disorders 1. Bronchial Asthma Asthmatic symptoms are induced by emotional stress. Bronchial asthma is common in fear, rejection, and mourning or pent op emotion, upset in dependency need.

15. Contd. Cardiovascular Disorders Hypertension, coronary heart disease (CHD). The most deadly and well – known form of coronary heart disease is myocardial infarction (MI). Hypertension increases the risk for CHD, as well as other serious disorders such as stroke. Type “A” personality is found to be linked with coronary heart disease (CHD). Type “A” personality includes excessive ambition, high performance standards, persistent urgency, competitiveness, aggressiveness and hostility.

16. Contd. 3. Peptic ulcer Stress and emotional disturbances  adreno – cortical secretion  increased acidity  progressive erosion of the mucosal wall in esophagus, stomach, duodenum or jejunum  increased inflammation and severe laceration  ulcer

17. Contd. Irritable Bowel Syndrome (IBS) Stress and anxiety may make the mind more aware of spasms in the colon. IBS may be triggered by the immune system which is affected by stress.

18. Contd. Ulcerative colitis Patients with a predominance of compulsive personality traits, and narcissistic personality traits, and are neat orderly and clean, punctual, hyper intellectual and inhibited in expressing their anger are associated with individuals who have ulcerative colitis. Disturbed personal relationship resulting in feeling off helplessness and hopelessness Stress  Grief, anxiety, disappointment, guilt, frustration, emotion suppression  triggers hypothalamic pituitary thyroid and adrenal axis  Lower immunity.

19. Contd. 6. Migraine and tension typed headache A severe recurring headache, usually affecting only one side of the head, that is characterized by sharp, throbbing pain and is often accompanied by nausea, vomiting, sensitivity to light and visual disturbances. Vasodilation in the brain causes inflammation that results in pain, but the exact cause is unknown.

20. Contd. Pain disorders: A pain disorder is characterized by the presence of, and focus on, pain in one or more body sites and is sufficiently severe to come to clinical attention. Patients experiencing bodily pain without identifiable and adequate physical causes may be symbolically expressing and intra – psychic conflict through the body. Pain behaviors are reinforced when rewarded and are inhibited when ignored or punished. Means for manipulating and gaining advantage in interpersonal relationships. Such secondary gain is most important to patients with pain disorder. Serotonin and endorphins play a role in pain disorders.

21. Contd . Malingering: Involves the intentional reporting of physical or psychological symptoms in order to achieve personal gains. Common external motivations include avoiding the police, receiving room and board, obtaining narcotics, and receiving monetary compensation. Factitious Disorder: Occurs when physical or psychological symptoms are intentionally produced or feigned to gain attention. Sole purpose is to draw others’ attention because of their sickness.

22. Clinical features Specific sensations, such as pain or shortness of breath, or more general symptoms, such as fatigue or weakness Unrelated to any medical cause that can be identified, or related to a medical condition such as cancer or heart disease, but more significant than what's usually expected A single symptom, multiple symptoms or varying symptoms Mild, moderate or severe

23. Contd. Constant worry about potential illness Viewing normal physical sensations as a sign of severe physical illness Fearing that symptoms are serious, even when there is no evidence Thinking that physical sensations are threatening or harmful Feeling that medical evaluation and treatment have not been adequate

24. Contd. Fearing that physical activity may cause damage to your body Repeatedly checking your body for abnormalities Frequent health care visits that don't relieve your concerns or that make them worse Being unresponsive to medical treatment or unusually sensitive to medication side effects Having a more severe impairment than is usually expected from a medical condition

25. Treatment A major role of psychiatrists and other physicians working with patients with psychosomatic disorders is mobilizing the patient to change behavior in ways that optimize the process of healing. This may require a general change in lifestyle (e.g., taking vacations) or a more specific behavioral change (e.g., giving up smoking). Whether or not this occurs depends in large measure on the quality of the relationship between doctor and patient.

26. Contd. Failure of the physician to establish good rapport accounts for much of the ineffectiveness in getting patients to change. Ideally, both physician and patient collaborate and decide on a course of action. At times this may resemble a negotiation in which doctor and patient discuss various options and reach a compromise about an agreed-on goal.

27. Contd. Direct education: Explain the problem, goals, and methods to achieve goals. Every effort should be made to convey to belligerent patients both understanding and tolerance for their feelings.

28. Contd. Third- party intervention : Family members, friends, and other clinicians can provide support and encourage the patient to follow a course of action

29. Contd. Exploration of options: There may be alternative methods for achieving a desired goal. For example, quitting smoking can be done with support groups, nicotine patches or gum, psychotropic drugs

30. Contd. Provision of sample treatment If a patient fears a particular course of action or considers change impossible, a treatment trial can be implemented. The patient always may opt out of the prescribed program. Control sharing: Some patients resent any approach that appears to be authoritarian. They may wish to set the pace of a withdrawal program or titrate their medication depending on adverse effects.

31. Contd. Concession making: The clinician may grant the patient something that he or she wants as a bargaining chip to get the patient to comply with advice. Empathic confrontation: Patients who resist change may do so because of fear or other uncomfortable emotions of which they are unaware.

32. Contd. Self Observation Cognitive restructuring Relaxation training Time management Problem Solving

33. Contd. Relaxation Therapy JPMR (Jacobson Progressive Muscle Relaxation) Benson Relaxation therapy Hypnosis Biofeedback

34. Contd. PROBLEM SOLVNIG : The final step is problem- solving in which patients basically try to apply the best solution to the problem situation and then review their progress with the therapist.

35. Physiotherapy plays a vital role in the management of psychosomatic disorders. It can help address physical symptoms, improve function, and reduce stress through various techniques: 1. Assessment and Individualized Treatment Plan  - Conduct a thorough assessment of the patient’s physical condition, taking into account psychological factors. - Develop an individualized treatment plan that incorporates both physical and psychological goals. 2. Education and Awareness  - Educate the patient about the mind-body connection and how psychological well-being impacts physical health. - Provide guidance on recognizing stress triggers and symptoms.

36. 3. Physical Modalities  - Manual Therapy: Techniques such as massage or mobilization can help alleviate muscle tension and pain. - Therapeutic Exercises: Customized exercise programs designed to enhance strength, flexibility, and endurance, tailored to the individual's needs. - Posture and Ergonomics: Training on proper body mechanics to reduce strain and prevent injury. Physiotherapy plays a vital role in the management of psychosomatic disorders. It can help address physical symptoms, improve function, and reduce stress through various techniques:

37. 4. Relaxation Techniques  - Breathing Exercises: Techniques such as diaphragmatic breathing to promote relaxation and reduce anxiety symptoms. - Mindfulness and Meditation: Introducing mindfulness practices can help patients manage stress and improve overall well-being.